How the tree grew, Or… the unintended consequences of improvement and change;

Several years ago we decided, to put-up pictures of our staff on the wall outside of the ward , with their names and roles – doctor, nurse, healthcare assistant, therapist and so on, to help relatives and carers know who was caring for their mother, father, husband or wife.

This was back in my very enthusiastic days, and so keen was I to do this that I brought my camera to work and took the photos myself.

I proceeded to take pictures of the staff, many of which, in the time before iPhones, and image correction software were a little wonky (portraiture is not one of my strong points). Very quickly however we had a gallery of the staff on the wall, we were able to let people know who we were and what we did.

This was also in the days before our current level of person-centredness, where the patients not knowing our names was not necessarily something we considered. (Thanks to Kate Granger, this has changed)

In the wake of the events at Mid-Staffs hospital and the Francis Report, there was a decision that all wards should publish the numbers of staff working, alongside the different grades over different shifts. This was a move to openness, although it was paradoxically, a little impersonal.

Given limited wall-space, our pictures, that I had so carefully stuck-up, were taken-down, and the new charts went up. There was space for a few photos, so my picture appeared, as did some shots of the ward manager, sisters and matron. The ‘others’ were back out of sight.

And here we come to the evolution of the team which has followed-on from my work with Helen Sanderson over the past couple of years, that, and thanks to iPhone technology, and the development of mini one-page profiles has resulted in a reappearance of staff photos, taken expertly by Gemma, our activities coordinator.

Our tree, a representation of those people working on the ward, both regular and visiting staff, has grown over the past couple of weeks (it went-up last month) and is on the wall at the entrance to the ward – visible to carers and relatives and this time, our patients.

And our tree does not just represent who we are – a team that has evolved beyond the basic constructs of organisation, leadership and management, it is the living embodiment of the care we provide. The tree, unlike traditional organisational structures, with the ‘important’ people at the top and everyone else below is a metaphor of our team, which isn’t hierarchical – it is a Gestalt, only real when everyone is valued and appreciated collectively.

And our tree, will, I hope, continue to grow, to flourish, like the care that is delivered on our ward; one day, I would love us to acquire photos or drawings of the people who are our patients, to commemorate the time they spend with us, to act as mementoes of our care; there are issues with confidentiality and privacy which need to be addressed; I am sure we will get there one day.

The tree, like the people who work on the ward and who receive our care are part of the art, part of the creation, the magic that is our team.

2 Replies to “How the tree grew, Or… the unintended consequences of improvement and change;”

Such an awesome Post and idea Rod. I love your idea about being able to document your patients in a creative and personal way – through photography and drawing as evidence and symbol of your care and their time/narrative. If you ever decide to figure out how to do it/push it forward – i’d love to see it! Because I’m so sure- as you’re constantly showing in your work – a more creative way can bring better personal care. And wish we could do more of it in practice without saying we’re being too ambitious. My PhD proposal is about using a creative practice to help empower, re-construct, highlight and explore the meaning in peoples (patients) narratives and quality of life issues of living with/dignosis of breast/trunkodema after b.c. Tx – & then using that to develop patient info & tools to compassionately educate HCP (cuz there’s this MASSIVE gap in practice in info / knowledege and understanding that then reflects in poorer care outcomes ). There’s something really interesting in using drawing – Drawing initiates the process of gaining knowledge but also evidences the progression of journey. Evidencing a process of how understanding can be developed & embedded in the marks and smudges made by the observer. So i’d be super cool to see you do it 🙂

Thanks Sarah – I might need to call on your expertise/talent to help… I wonder if we could perhaps look at our patients doing the drawing? Sweden was an exhilarating trip & made me realise that there are many others out there who share our ideas – just need to bring us all together and we will be unstoppable!!!